Children's Sleep Habits Research Articles

Assessment of sleep problems in patients with Kawasaki disease: a survey-based study.

Kawasaki disease (KD) is a rare systemic inflammatory disease that primarily affects children under the age of five. It is now recognized as the most prevalent cause of acquired heart diseases in children in developed countries. The aim of this study was to evaluate sleep disturbances in patients with KD and identify their prevalence and associations. This cross-sectional analytic survey-based study was carried out on 262 participants (130 KD patients and 132 age- and sex-matched healthy controls). Participants were invited via social media groups. Sociodemographic data, clinical characteristics and therapeutic data of KD patients were collected. To identify the presence of sleep disturbances, all participants completed Children's Sleep Habits Questionnaire (CSHQ). The median age for KD patients was 6 years, and 51.5% of them were female, the median age at disease onset was 2.5 years, and the median disease duration was 3 years. The sleep scores of patients with KD were significantly higher than those of the control group (55.72 ± 11.97 vs. 49.45 ± 8.54, p < 0.001). The total duration of sleep did not exhibit any statistically significant difference between patients with KD and healthy controls (p = 0.399). KD patients exhibited significantly elevated scores in sleep onset delay, sleep duration, night wakings, parasomnias, and sleep-disordered breathing (p < 0.001). Additionally, they showed marginally higher scores in daytime sleepiness (p = 0.059). Younger age of KD patients was associated with higher rates of bedtime resistance (p < 0.001) and sleep anxiety (p = 0.005). Younger age at KD onset was associated significantly with higher rates of bedtime resistance (p = 0.009), sleep anxiety (p = 0.038), night wakings (p = 0.017), and worse sleep quality (p = 0.033). KD Patients who exhibited lethargy, and received corticosteroid medication had significantly higher sleep scores than those who did not. Patients with KD experience higher sleep disturbance than their healthy counterparts. Young age, early disease onset, lethargy and corticosteroid administration are linked to poor sleep quality.

Sleep complaints in individuals with SYNGAP1-associated syndrome.

Neurodevelopmental disorders pose significant clinical challenges related to atypical brain development, often manifesting as learning disabilities, developmental delays, intellectual deficits, behavioral issues, epilepsy, and sleep disturbances. Among genetic neuropsychiatric conditions, synaptopathies are notable for their impact on synaptic function, resulting in varied neuropsychiatric phenotypes. Among these, SYNGAP1-associated syndrome is characterized by intellectual disability, global developmental delay, autism, and epilepsy, primarily due to loss-of-function mutations. This study explored sleep behaviors in children with SYNGAP1-associated syndrome, using the Children's Sleep Habit Questionnaire and the Sleep Disturbance Scale for Children, comparing results with neurotypical controls matched for age and sex. The cohort included 23 individuals with confirmed SYNGAP1 mutations. Results indicated that 78.3% of participants had epilepsy, often resistant to treatment. Neurodivergent individuals had significantly higher sleep disturbance scores than neurotypical peers, exhibiting increased bedtime resistance, longer sleep durations, and more frequent night awakenings. Additionally, neurodivergent children showed a greater need for parental presence to fall asleep and struggled with sleeping away from home. Neurodivergents' caregivers reported poor sleep quality, emphasizing the complex dynamics of caregiving in these situations. The study highlights the urgent need for targeted interventions to enhance sleep quality for affected children and their caregivers, underscoring the critical link between neurodevelopmental disorders and sleep disturbances.

Psychiatric characteristics of child survivors after the Kahramanmaraş double earthquake.

The two strongest earthquakes in Turkey for eight decades hit Kahramanmaraş province on February 6, 2023. This study aimed to determine psychiatric complaints, acute stress symptoms, anxiety, depression, and sleep characteristics in children who were treated in a tertiary inpatient pediatric unit after the earthquakes. They were evaluated in the fourth week after the earthquake. Trauma experiences and acute stress disorders were evaluated by child and adolescent psychiatrists, sleep characteristics were examined by the Child Sleep Habits Questionnaire (CSHQ), and the anxiety and depressive symptoms were investigated using the Revised Child Anxiety and Depression Scale (RCADS). Forty-two patients aged 1-17 were included. Trauma experiences and acute stress disorder symptoms were similar for all age groups examined. There were no significant differences in RCADS or CSHQ scores based on age or gender groups. There were significant differences in RCADS scores when the children were grouped as having parental loss or not and, similarly, there were significant differences in sleep anxiety and resistance to bedtime in CSHQ between these children. This research offered baseline findings about psychological outcomes after these earthquakes in child survivors, and it may provide a further basis to assess the effect of psychological interventions after earthquakes. These results may offer a foundation for suitable psychological interventions for children in developing countries.

Profile of sleep problems and its relation to sleeping habits in toddlers

Background: Sleep is essential for the neurological development, cognition and behavior of children. Sleep problems affect 15-40% of children globally, with a prevalence of 47.5% in India. This study aimed to determine the prevalence and profile of sleep problems in toddlers aged 1-3 years. Methods: A 24-month cross-sectional study was conducted in rural Bangalore with 1,255 children aged 1-3 years visiting the outpatient department. Sleep problems were assessed using the Children's Sleep Habits Questionnaire (CSHQ). A Total Sleep Disturbance score of 41 or higher, based on responses to all 33 items across the eight subscales, suggests the presence of a sleep disturbance. Results: Of the children, 48.3% experienced sleep problems, with a higher prevalence in children aged 1-2 years (32.7%) compared to 2-3 years (67.3%). Most children (54.7%) were male. The most common bedtime was 9:00 pm. Average sleep durations were: 9.41±1.55 hours at night, 2.30±0.79 hours during the day and 11.80±1.43 hours total sleep. Most children woke up twice during the night (28%). The mean CSHQ score was 40.55±4.24. Factors such as age, bedtime and number of awakenings were linked to sleep problems. The lowest prevalence was found in those sleeping at 8:30 pm (18.2%). Sleep problems were more common in children with 4 nighttime awakenings (75%). Conclusions: Sleep disorders are common in toddlers, highlighting the need for pediatricians to identify and address sleep problems early.

Processed Food Consumption and Sleep Quality in School-Aged Children: Insights from a Cross-Sectional Study.

This cross-sectional study aimed to investigate the association between processed food consumption and sleep quality among school-aged children. Our sample consisted of 137 children, with 52.6% being girls with a mean age of 7.9 ± 1.2 years. Moreover, 40.2% of children had overweight and 35.9% had experienced sleep problems. Dietary intake was evaluated using two non-consecutive 24 h recalls, and foods were categorized according to the NOVA classification system. The amount of sweet snacks consumed, in grams, was recorded for each meal and throughout the day. Sleep quality was assessed using the Portuguese Children's Sleep Habits Questionnaire (CSHQ-PT). The study found a significant and positive association between the sleep habits score and daily sweet snack consumption (B = 0.035; 95% CI: 0.011, 0.059). Additionally, there were higher odds of experiencing sleep problems in those children who consumed a higher percentage of energy from ultra-processed foods (OR: 1.043; 95% CI: 1.004, 1.084), higher total daily consumption of sweet snacks (OR: 1.016; 95% CI: 1.006, 1.026), particularly during morning and afternoon snack times (OR: 1.018; 95% CI: 1.002, 1.033). These findings underscore the importance of addressing dietary patterns on children's sleep quality. Future interventions should account for reducing NOVA 4 and sweet snack consumption in order to improve sleep quality.

Effect of Screen Time and Sugar Consumption Reduction on Sleep Bruxism in Children: A Randomised Clinical Trial.

Sleep bruxism (SB) is associated with alterations in dopamine and serotonin, which are related to increased consumption of added sugar and overuse of screens. The aim of this study was to compare the effect of the interventions 'Food, Fun and Family' (FFF) and Counselling and Education (CE) on the frequency of SB in children. A randomised clinical trial was conducted. Forty-eight participants aged between 4 and 8 years, attending the paediatric clinics of Universidad CES (Colombia) and Hospital Elina de la Serna (Argentina) participated in the study. Subjects were randomised into the FFF (experimental) and CE (regular intervention) groups. The frequency of SB was reported with the Children's Sleep Habits Questionnaire (CSHQ), the consumption of added sugar from items with the HBSC-FFQ and the time of use of screens through a diary in baseline (before starting the intervention), at Week 6 and Week 12. Data were analysed with Kruskal-Wallis test followed by Dunn's post hoc, Mann-Whitney test, a linear mixed model and logistic ordinal regression analyses. The FFF group had a more significant reduction in consumption of added sugar and screen time compared to the CE group (p < 0.05), especially from Week 6 to baseline. Regression analysis showed that reducing TV watching and consumption of added sugar were associated with a decrease in SB frequency, especially in the FFF group (OR < 1, p < 0.05), and the results were consistent across different study environments. The FFF intervention was more effective in reducing the screen time and sugar consumption and thus decreased the frequency of SB, when compared with the CE intervention. ClinicalTrials.gov identifier: NCT05310162.

Effect of comorbid allergic diseases on attention-deficit hyperactivity disorder symptoms and sleep: A cross-sectional study.

Recent studies have shown a close relationship between attention-deficit hyperactivity disorder (ADHD) and allergic diseases in children. Regrettably, few studies have investigated the effect of comorbid allergies on ADHD symptoms and sleep, in particular, it is unclear whether comorbid allergic conditions further exacerbate sleep problems in children with ADHD. To investigate the effect of comorbid allergic on symptoms and sleep in children with ADHD. This was a cross-sectional study, 222 ADHD children (aged 6-14 years) were enrolled in, of whom 93 had allergic diseases and 129 without allergic diseases. Collected all ADHD symptom severity and functional impairment scales, including: Swanson, Nolan and Pelham (SNAP) scale, Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Conners Parents Symptom questionnaire (PSQ) and Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P). Every guardian of children diagnosed with ADHD is required to complete the Children's Sleep Habits Questionnaire (CSHQ). Compared to ADHD children without allergic diseases, we observed significantly higher hyperactivity and impulsivity scores on the SNAP-IV, higher hyperactivity index and impulsivity index on the PSQ, and higher risky activities on the WFIRS-P in ADHD children with comorbid allergic diseases (all p < 0.05). CSHQ total score and sleep disordered breathing were particularly prominent in ADHD children with comorbid allergic diseases (all p < 0.05), and changes in CSHQ correlate with ADHD symptoms and functional impairment. Further analyses revealed that ADHD symptoms and sleep did not worsen with increasing number of comorbid allergic diseases (all p > 0.05). The primary influence on ADHD symptoms and sleep was the type of allergic diseases, where food allergies predominantly influence ADHD symptoms, including attention deficit disorder and hyperactivity disorder (all p < 0.05); allergic rhinitis notably impacts parasomnias, sleep disordered breathing (all p < 0.05); and allergic asthma significantly affects sleep anxiety, daytime sleepiness, and sleep disordered breathing in children with ADHD (all p < 0.05). The presence of comorbid allergic diseases affects both the hyperactivity and impulsivity symptoms of ADHD and sleep disordered breathing, predominantly influenced by the type of the allergic diseases.

Impact of sleep hygiene education on sleep and nutrition in children aged 10-18 years.

Sleep quality has positive effects on children's sleep and eating habits. In turn, improvement in sleep quality is associated with sleep hygiene training. The aim of our study was to determine the impact of sleep hygiene education on sleep and nutrition management in children aged 10-18 years. In addition, we explored the association between sleep problems and eating behaviours in participants before and after the training programme. We conducted a quasi-experimental study between August 25 and December 27, 2023, in children aged 10-18 years who participated in the study on a voluntary basis with the consent of their parents. We collected data from a total of 80 children aged 12-18 years. The study investigated the relationship between sleep problems and eating behaviours. We randomly allocated participants to one of two groups, the training group or the waitlist group. We assessed the association between changes in sleep problems and changes in eating behaviours in the training group. The data were collected using a sociodemographic data form, the Children's Sleep Habits Questionnaire, and the Three-Factor Eating Questionnaire. In the study sample, the proportions of male and female participants (training group) were 60.0% and 40.0%, respectively. There was a statistically significant difference between the pretest and post-test scores in the Children's Sleep Habits Questionnaire and the Three-Factor Eating Questionnaire (P < .01) and significant differences in the changes in sleep and eating habit scores between groups between the pre- and post-sleep hygiene training timepoints (P < .01). Thus, we concluded that sleep hygiene training is associated with and has an impact on sleep and nutrition. We observed that in children aged 10-18 years, sleep problems were associated with their eating behaviours. Sleep hygiene education had a significant and favourable impact on sleep and nutrition outcomes. Thus, sleep hygiene training has an important effect on children's sleep and diet.

Sleep and breathing in children with Joubert syndrome and a review of other rare congenital hindbrain malformations.

Joubert syndrome (JS) is an autosomal recessive disorder with a distinctive mid-hindbrain malformation known as the "molar tooth sign" which involves the breathing control center and its connections with other structures. Literature has reported significant respiratory abnormalities which included hyperpnea interspersed with apneic episodes during wakefulness. Larger-scale studies looking at polysomnographic findings or subjective reports of sleep problems in this population have not yet been published. The primary objectives were (1) compare a large group of children with JS and their unaffected siblings for caregiver-reported sleep difficulties. Secondary objectives were (1) present new polysomnography (PSG) data on our JS cohort; (2) review sleep disordered breathing (SDB) in other rare congenital hindbrain anatomic abnormalities. We conducted a cross-sectional study on a cohort of 109 families affected by JS. Pediatric Sleep Questionnaire (PSQ) and the Children's Sleep Habits Questionnaire (CSHQ) along with general medical health information focused on respiratory and sleep problems were mailed to all patients and families. Caregivers were asked to complete the survey for both children with JS and unaffected siblings, if any. Baseline diagnostic PSG was retrospectively reviewed for those with available studies, and the sleep parameters were compared to a referent cohort. Study participants with JS were older than their unaffected siblings (p = 0.02). Genetic mutations were available for 41 out of 118 individuals, with the most common mutation being MKS3 (31.4%). Patients with JS had higher scores in the PSQ compared to their unaffected siblings (p < 0.001). PSG data showed severe SDB with apnea-hypopnea index (AHI) of 23 ± 15 events/h in patients with JS. Events were primarily obstructive (obstructive AHI 18 ± 15 events/h vs central AHI 4 ± 4 events/h). Abnormal sleep architecture with increased arousal indices, decreased efficiency, and more time awake and in light sleep or wakefulness when compared to the referent data. SDB is common and severe in patients with JS, and the significantly greater obstructive component reported in this cohort makes it necessary to perform complete PSG studies to address or prevent clinical manifestations in this at-risk population. PSQ could represent a viable method to screen for SDB in JS.

Resting-state microstate dynamics abnormalities in children with ADHD and co-occurring sleep problems.

Children with attention-deficit/hyperactivity disorder often experience sleep problems, exacerbating symptoms, and cognitive deficits. However, the neurophysiological mechanisms underlying such deficits remained unclear. This study aims to use resting-state microstate analysis to investigate the neurophysiological characteristics in children with ADHD and sleep problems and explore whether neurophysiological abnormalities are associated with sleep problems. Five-minute eyes-closed resting-state EEG data were collected in 34 children with both ADHD and sleep problems, 32 children with ADHD without sleep problems, and 22 healthy controls aged 6-12 years. Participants' parents completed the ADHD Rating Scale, Behavioral Rating Inventory of Executive Function, and Children's Sleep Habits Questionnaire. Five minutes of eyes-closed resting-state EEG data were collected, and agglomerative hierarchical clustering was used for microstate analysis. ANCOVAs, adjusted for sex and IQ, were used to compare ADHD symptoms, executive function, and microstate parameters across groups. Pearson partial correlations, controlling for sex and IQ, examined the association between microstate parameters and sleep problems. Children with both ADHD and sleep problems exhibited more severe inattentive (20.4±3.1 vs 18.0±3.4, p<0.05) and total symptoms (14.3±6.0 vs 13.0±5.3, p<0.05), along with greater deficits in emotional regulation (1.88±0.58 vs 1.60±0.42, p<0.05, organizational of materials 2.56±0.41 vs 2.20±0.55, p<0.05, behavioral regulation (1.88±0.40 vs 1.70±0.36, p<0.05), and global executive function (2.14±0.30 vs 1.95±0.30, p<0.05), compared to children with ADHD without sleep problems. Moreover, Both ADHD groups exhibited significantly reduced microstate D occurrence and lower transition probability from microstate C to D compared to healthy controls (all p<0.05). Additionally, no significant correlation was found between sleep problems and microstate parameters in all three groups after adjustment (all p>0.05). Children with both ADHD and sleep problems showed greater symptom severity and more pronounced executive function deficits compared to children with ADHD without sleep problems and healthy controls. Additionally, both ADHD groups showed overlapping atypical microstate parameters, suggesting children with co-occurring ADHD and sleep problems may share similar aberrant neurophysiological characteristics with children with ADHD alone. Resting-state EEG microstate parameters may serve as a sensitive tool for assessing sleep problems in children with ADHD, distinguishing them from typically developing children.

Children with autism spectrum disorder's sleep patterns: a research analysis

Sleep issues are common in young with autism spectrum disorder (ASD), and although the Children's Sleep Habits Questionnaire (CSHQ) is widely used for assessment, concerns about its ideal variable structure still exist. This research looked at the CSHQ's variable structure in young children with ASD and explored the relationship between CSHQ variables and emotional, cognitive, and behavioral dysregulation. Children with ASD between the ages of 4 and 5 (n = 270) took part in the research. Two previously published CSHQ variable frameworks were tested for data using confirmatory factor analysis (CFA), and other frameworks were investigated using exploratory factor analysis (EFA). Regression analysis evaluated how differences in dysregulation symptoms were explained by the values of the variables.previously published frameworks for validated, a novel five-variable system discovered by EFA showed a great fit with the Although sleep characteristics were not generally linked to autistic symptoms, there was evidence of particular associations between them and aggression, stress, depression, and attention deficit problems. These results highlight how common sleep issues are in young children with ASD and indicate that the recently discovered CSHQ five-variable approach may be useful in future studies.

Dimensional Validation of the Italian Revised Version of the Children's Sleep Habits Questionnaire (CSHQ-r) for Children and Adolescents with ASD.

Sleep problems are common in children with autism spectrum disorder (ASD), with potential repercussions on neurobehavioral functioning exacerbating socio-communicative impairments and aggressive behaviors. Parent reports are the most used method to assess sleep in pediatric populations and a modified 23-item of Children's Sleep Habits Questionnaire (CSHQ) for ASD has been proposed in the United States. The generalizability of the CSHQ for ASD has yet to be validated across countries, including Italy. To extend the CSHQ applicability to Italian youth with ASD, we back-translated to Italian and revised the 23-item CSHQ, validating its dimensional structure in a sample of children and adolescents with ASD using Explorative Graph Analysis. In addition, we compared the revised scale scores of the ASD group with a typically developing (TD) group. The revised Italian version of the CSHQ (CSHQ-r) consisted of a 15-item tool with a four-dimension structure (Sleep initiation/duration, Sleep anxiety/Co-sleeping, Night awakenings/Parasomnias, and Daytime alertness) with good structural stability. Group comparison indicated significantly higher scores in the ASD group than the TD group, suggesting greater prevalence of sleep disturbances in ASD. The four-dimensional CSHQ-r may represent a useful screening tool to assess sleep disorders in Italian children and adolescents with ASD, with potential implications for clinical practice.

Anxiety and Depression and Sleep Problems Among Patients with Fetal Alcohol Spectrum Disorders.

Background/Objectives: Sleep disturbances are common among children with fetal alcohol spectrum disorders (FASD) and are often accompanied by emotional and behavioral challenges. This study aimed to evaluate the relationship between sleep problems, anxiety, and depressive symptoms in children with FASD. Methods: The study included 90 children aged 7 to 16 years diagnosed with FASD, who were primarily in foster or adoptive care. Participants completed validated psychometric tools, including the Children's Sleep Habits Questionnaire (CSHQ), State Trait Anxiety Inventory for Children (STAIC) and Children's Depression Inventory 2 (CDI 2). Results: Sleep disturbances were significant, with 71.1% of participants scoring above the clinical threshold in CSHQ. State anxiety, measured by STAIC C-1, was positively correlated with specific sleep difficulties, such as bedtime resistance (r = 0.30, p = 0.008) and sleep anxiety (r = 0.31, p = 0.005). However, no correlation was found between trait anxiety (STAIC C-2) and sleep problems. Parent-reported depressive symptoms, measured using CDI 2:P, were strongly associated with general sleep disturbances (r = 0.27, p < 0.011), parasomnias (r = 0.33, p = 0.002) and daytime sleepiness (r = 0.34, p < 0.001). Conclusions: These findings suggest that sleep disturbances in children with FASD are closely related to state anxiety and depressive symptoms. The results emphasize the need for targeted interventions addressing sleep and emotional health in this population. Further research is needed to examine these relationships and their implications for clinical practice.

Effects of immune modulatory treatment on language and psychiatric profile in patients with electrical status epilepticus in sleep (ESES).

Electrical status epilepticus in sleep (ESES) is an electrographic pattern associated with cognitive impairment. Our study aimed to prospectively evaluate the psychiatric findings and language skills in patients diagnosed with ESES and to determine the immune modulatory treatment-responsive subgroups. We assessed the patients for psychiatric features and language skills at the baseline and 12months after. Psychiatric disorders were screened according to DSM-V criteria. We implemented standardized tests including Clinical Global Impressions-Severity Scale (CGI-S), Revised-Children Anxiety and Depression Scale, Children's Sleep Habits Questionnaire-Abbreviated, Aberrant Behavior Checklist (ABC), and Childhood Autism Rating Scale. We used tests adapted/developed for Turkish language including Test of Language Development-Primary-Fourth Edition: Turkish (TOLDP-4:T), Turkish Non-word Repetition Test (TNRT), Turkish Multilingual Sentence Repetition Test (MultiSIT-TR) and Turkish Communication Development Inventory (TCDI). Disability was evaluated by Pediatric Evaluation of Disability Inventory (PEDI). Thirty-nine patients were included. Psychiatric evaluation revealed attention deficit hyperactivity disorder-like symptoms in 25 patients, intellectual disability in 12, and specific learning disability in 8. Patients were treated with corticosteroids or IVIg in addition to anti-seizure medication. The spike wave indexes improved significantly at the end of follow-up period (80% (65-91) vs. 37% (24-65), p<0.001). After 12months, statistically significant improvement was found in ABC, CGI-S, TOLDP-4:T, TNRT, MultiSIT-TR, TCDI, and PEDI scores (p<0.05). Patients with improvement in psychiatric symptoms had earlier age. Phonologic working memory performance was significantly preserved and improved compared to other language domains. Immune modulatory treatments may contribute to improvement of psychiatric symptoms and language skills. Preservation of phonologic working memory and grammar performance might be a valuable feature to differentiate ESES-related language impairment.

The efficacy of behavioral sleep intervention on sleep problems among children with attention-deficit hyperactivity disorder: A randomized controlled trial.

Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges. This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD. A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV). Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology. This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD. The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.

Evaluation of the Sleep Habits and Dental Problems in Children Exposed to Secondhand Smoke During Childhood.

Clinically, data on the association of early-life secondhand smoke (SHS) exposure with sleep bruxism and dental problems are scarce. To examine whether the relationship between early-life SHS exposure with sleep problems, sleep bruxism, and dental problems in children. Within the scope of this study, questionnaires were applied to the volunteer parents of 710 children, aged 5-12 years old. The questionnaire applied in this study named as Children's Sleep Habits Questionnaire (CSHQ) and consists of seven subscales and a total of 33 items. The questionnaire was completed retrospectively by any parent, and the presence of sleep bruxism was questioned during the anamnesis. Afterward, the presence of dental decay and tooth wear was evaluated during intraoral and radiographic examinations. Dental decay and tooth wear were scored with the DMFT/deft index and tooth wear index of Smith & Knight, respectively. The presence of sleep bruxism was significantly higher in children with parasomnia (p = 0.01; p < 0.05). The presence of tooth wear in children with sleep bruxism was found to be statistically significant (p = 0.032; p < 0.05). It was observed that the presence of sleep bruxism was higher in the children of individuals who smoked at home (p = 0.027; p < 0.05). Sleep bruxism, untreated dental decay and exposure to early-life secondhand smoke may have a negative impact on children's sleep habits and characteristics.

Effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation on sleep disorders and EEG in children with spastic cerebral palsy

To investigate the effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on sleep disorders and EEG activity in children with spastic cerebral palsy (CP). By using stratified randomization method, 100 children of spastic CP with sleep disorders were randomly assigned to a control group and an observation group, with 50 cases in each group. The patients in the control group were treated with medication, comprehensive rehabilitation training, and low-frequency rTMS, while the patients in the observation group were treated with Jin's three-needles therapy in addition to the interventions given to the control group. Acupoints selected included temporal three needles, brain three needles, intelligence three needles, four spirits needles, and bilateral Ganshu (BL 18), Shenshu (BL 23), Shenmai (BL 62), and Zhaohai (KI 6). Treatment was given once daily, five times a week, for 12 weeks. The Pittsburgh sleep quality index (PSQI) and children's sleep habits questionnaire (CSHQ) scores, modified Ashworth grade, Peabody developmental motor scales-2 (PDMS-2) score, and relative power values of δ, θ, β1, and β2 frequency bands in EEG were observed before and after treatment in both groups. Treatment safety was also evaluated. Compared before treatment, PSQI and CSHQ scores were decreased in both groups after treatment (P<0.05), with lower scores in the observation group than the control group (P<0.05). The modified Ashworth grade showed improvement (P<0.05), with better results in the observation group (P<0.05). PDMS-2 scores were increased in all dimensions (P<0.05), with higher scores in the observation group (P<0.05). Relative power values of δ and θ frequency bands in EEG were decreased (P<0.05), with lower values in the observation group (P<0.05), while relative power values of β1 and β2 frequency bands were increased (P<0.05), with higher values in the observation group (P<0.05). Children in both groups did not occurred obvious adverse reactions. Jin's three-needles therapy combined with low-frequency rTMS can effectively improve sleep disorders, spasticity and motor function, regulate EEG activity in children with spastic CP and sleep disorder, and have good safety.

Are the Sleep-Wake Cycle and Sleep Duration Ethnically Determined? A Comparison of Tibetan and Japanese Children's Sleep.

Several environmental factors affect sleep. We investigated the sleep and sleep-related habits of preschool children living in Tibet and conducted an international comparison with those in Japan. We conducted a community-based cross-sectional study using the Chinese version of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P-C) and compared the results with previous data on Japanese children. The sleep status of 3113 children aged 3-6 years old in Qinghai province was evaluated. The average wake time and bedtime of the Tibetan children were 7:20 ± 0:31 and 21:16 ± 0:43, respectively. Their mean nocturnal sleep duration was 10.0 ± 0.7 h. In comparing 3-year-old children, the time for which they viewed TV in Tibet was shorter (65.5 ± 44.6 min) than that in Japan (149.7 ± 76.6 min), and the mother's bedtime was earlier in Tibet (21:28 ± 2:14) than in Japan (23:20 ± 1:05). However, the bedtime and sleep duration of the Tibetan children (21:17 ± 0:37 and 10.0 ± 0.7 h) were fairly similar to those of the Japanese children (21:24 ± 1:57 and 9.8 ± 0.8 h). The late bedtime and short nocturnal sleep duration of Tibetan toddlers were the same as those of Japanese toddlers despite considerable differences in their lifestyle and environment.

Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age

To describe the developmental pattern for physical activity (PA) in children 6-36months of age and to identify factors that are longitudinally associated with PA as children transition from infancy to preschool age. The study employed a prospective longitudinal design with baseline data collected when children were approximately 6months of age. Mothers and infants (n=124) were recruited through community and educational settings in South Carolina. Data were collected at 6-month intervals from 6 to 36months. PA was measured via accelerometry. Mothers completed questionnaires that assessed independent variables, including parent characteristics, the child's sex, race, and ethnicity, birth/delivery type, motor milestones, sleep habits, dietary practices, childcare setting, and home environmental factors. Trained research staff administered anthropometric measures and assessed motor developmental status. Growth curve models described the age-related pattern for PA and evaluated relationships between independent variables and change in PA. PA increased by approximately 45% between 6 and 36months of age and followed a curvilinear pattern, with most of the increase occurring between 6 and 24months. The child's exposure to television/electronic media was negatively associated with change in PA, and the presence of older siblings in the home was positively associated with change in PA. As children develop from infancy to early childhood, their PA increases substantially, with most of the increase occurring by 24months of age.

The Effects of Problematic Media Tools Use on Sleep Habits in Children: A Primary School-based Study

The Effects of Problematic Media Tools Use on Sleep Habits in Children: A Primary School-based Study